Author + information
- W.Douglas Weaver, MD, FACC∗
- ↵∗Address for correspondence: Dr W. Douglas Weaver, MITI Coordinating Center, 1910 Fairview Avenue East, No. 205, Seattle, Washington 98102.
One of the major limitations to realizing the full potential of the life-saving effects of thrombolytic therapy has been the failure to initiate treatment in the first 1 to 1.5 h after symptom onset. The barriers to early treatment include the following: 1). Most patients fail to react rapidly and appropriately to symptoms. 2) Few emergency medical/paramedic systems have established effective traige systems for patients with chest pain or have implemented prehospital electrocardiography to better manage patients with possible acute myocardial infarction. 3) Time to treatment after hospital arrival currently averages 1 to 1.5 h—two to three times longer than what should be necessary to initiate therapy in the patients with typical electrocardiographic and clinical findings and co-morbid risk factors. Trials evaluating the effects of prehospital-initiated therapy have all shown trends toward a reduction in mortality (1.8%) associated with early treatment; however, none has been large enough in and of itself to be conclusive. The goal in the corning years will be to decrease each of these components of delay by developing effective education programs for the lay public speeding and improving prehospital care by the routine use of electrocardiography and reducing hospital treatment times to ≤ 30 min in the “uncomplicated” patient.